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Pica And Autism: What To Do When This Eating Disorder Occurs In Autistic People

by — Last updated: 2020-01-10 in Mental Health

Pica is an eating disorder that causes people to ingest non-food items like sand or soap. Research has shown it to be more prevalent in autistic people, but we also know behavioral therapy can help.

Pica is a relatively little-known condition that's more prevalent in people on the autism spectrum. What do you need to know about pica — and what should you do if someone you care for, like your child, is showing signs of it? Let's take a deeper look. 

What is pica?

Pica is an eating disorder. Like other eating disorders, it's dangerous. Pica isn't anything like other eating disorders, however. 

While many of the diagnostic lists in the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5), used to diagnose a wide variety of mental health and related conditions in the US, are quite complex, the criteria for pica are actually incredibly straightforward. We'll just share them with you, then:

  • People with pica eat non-food substances persistently for at least one month. 
  • This practice is not appropriate for the person's developmental level. 
  • These strange eating habits aren't part of the person's culture. 
  • In case eating non-food items is related to another medical condition, it has to be severe enough to require medical attention to warrant a diagnosis. 
So, pica is characterized by eating stuff that isn't food. Some examples of things people with pica might start craving would include soap, deodorant sticks, paper, chalk, sand, cigarette butts, glass, excrement, and hair, but it really can be anything. As you can imagine, consuming non-food items on the regular can have widely varying health consequences that depend both on what's being eaten and how much of it a person is ingesting. They can range from digestive upsets to choking and even poisoning.

To be diagnosed with the disorder, a person must have been eating non-food items for at least a month. They must also be capable of understanding that this isn't a good idea, and the practice shouldn't be culturally normative or acceptable. If that diagnostic criterion surprises you, consider, for instance, that it's not that uncommon for people in some Kenyan communities to take a liking to eating soft rocks known as odowa. You've probably also heard of pregnant women eating weird things that go far beyond pickle-topped ice cream, and the fact that cravings are common in pregnancy explains why it's not seen as especially unusual. So, there's also a bit about a need for the condition to be severe enough to cause medical concerns in cases where pica is caused by underlying issues including pregnancy. 

The interesting thing is that the DSM-5 also specifically mentions autism here — because pica is quite prevalent in people on the spectrum. In fact, research shows that around 28 percent of autistic preschoolers with intellectual impairment have pica, while 14 percent of those without intellectual impairment do. Less than four percent of neurotypical preschoolers eat non-food items on a regular basis, meanwhile. 

What should you do if an autistic person you care about has pica?

Pica can set in at any age, and risk factors among those on the autism spectrum may include seeking sensory stimulation (something anyone who likes to chew on the end of a pen can relate to on some level), stress or anxiety, nutritional deficiencies (which the person's body subconsciously tries to make up for by eating non-food items high in certain nutrients), and not being able to tell what is and isn't food. 

Pica is undeniably a fascinating eating disorder, but it can also be awfully dangerous. Consequences can range from severe dental damage to liver failure and even death. It's key for a person with pica to stop eating non-food items, then. 

Since pica does, like other eating disorders, present with behaviors that very much mimic those of addiction and pica sufferers on the autism spectrum may be both unable to stop and unable to recognize that the pica is causing health issues, professional help is very much needed. Research has shown that behavioral therapy can be successful in helping autistic people overcome the compulsive eating of non-food items. 

A combination of different strategies can be used to manage pica in the meantime:

  • Where pica occurs in a child or person with intellectual disabilities, increased supervision can help prevent the person from eating non-food items.
  • In some cases, educating the person suffering from pica about the health risks of ingesting the specific non-food items they've taken a liking to may help them become more motivated to participate in treatment for the disorder. 
  • Where a person's pica is mainly caused by sensory-seeking behaviors, it may help to find another way for the person to "stim" orally. Pacifiers and chewing jewelry ("chewlery") both have rubbery textures that may not satisfy every person with pica, as some prefer gritty or hard textures, but they can satisfy some people. 
The treatment of all eating disorders is incredibly complex, and pica is no exception. It may take a while to find the right approach for an individual suffering from pica. It will take caregivers, doctors, dentists, and therapists working together — where possible, right alongside the patient — to make a difference. Research has shown that behavioral therapy yields positive results, however, and that autistic people can successfully overcome pica. 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA
  • Photo courtesy of SteadyHealth

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